Effects of Postprandial Blood Pressure on Gait Parameters in Older People

Abstract

Postprandial hypotension (PPH), a fall in systolic blood pressure (SBP) within 2 h of a meal, may detrimentally affect gait parameters and increase the falls risk in older people. We aimed to determine the effects of postprandial SBP on heart rate (HR), gait speed, and stride length, double-support time and swing time variability in older subjects with and without PPH. Twenty-nine subjects were studied on three days: glucose (“G”), water and walk (“WW”), glucose and walk (“GW”). Subjects consumed a glucose drink on “G” and “GW” and water on “WW”. The “G” day determined which subjects had PPH. On “WW” and “GW” gait was analyzed. Sixteen subjects demonstrated PPH. In this group, there were significant changes in gait speed (p = 0.040) on “WW” and double-support time variability (p = 0.027) on “GW”. The area under the curve for the change in gait parameters from baseline was not significant on any study day. Among subjects without PPH, SBP increased on “WW” (p < 0.005) and all gait parameters remained unchanged on all study days. These findings suggest that by changing gait parameters, PPH may contribute to an increased falls risk in the older person with PPH.

What Is the Relationship Between Orthostatic Blood Pressure and Spatiotemporal Gait in Later Life?

“…Gray-Miceli et al found that older adults with OH in long-term care were less likely to walk in a steady line 25 while Nair et al demonstrated that postprandial hypotension was associated with changes in gait speed and double support time. 26 Older adults with a history of falls and OH have also been shown to spend longer in stance than nonfallers and had lower stance and swing time variability than non-OH fallers but not controls. 27 This study therefore adds significantly to existing literature in this field by including a large, well-described population-based cohort of community-dwelling adults, using continuous beat-to-beat values of orthostatic BP alongside spatiotemporal gait analysis.…”

“…Existing research is limited to three studies with fewer than 50 participants. Gray‐Miceli et al found that older adults with OH in long‐term care were less likely to walk in a steady line while Nair et al demonstrated that postprandial hypotension was associated with changes in gait speed and double support time . Older adults with a history of falls and OH have also been shown to spend longer in stance than nonfallers and had lower stance and swing time variability than non‐OH fallers but not controls .…”

Acute Effects of Nutritive and Non-Nutritive Sweeteners on Postprandial Blood Pressure

“…The majority of studies investigating PPH have utilised an oral [11,12,13,16,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73], and/or ID glucose [14,18,74,75,76,77,78,79,80,81,82,83,84,85,86,87,88] load that induces a substantial fall in BP. There have been a total of 58 studies related to effects of glucose on postprandial BP in a range of cohorts including health [11,12,14,16,18,39,40,41...…”

“…Due to its ability to induce a prominent hypotensive response, several studies investigating non-pharmacological [63,67,68,84,86,87] and pharmacological [18,55,57,58,59,60,61,64,65,83,85,88] approaches to the management of PPH have used glucose as test meals. Interventions based on slowing gastric emptying [63,84] and small intestinal absorption of nutrients [82] attenuate the postprandial fall in BP.…”

“…Guar gum, a vegetable-based, gel-forming non-absorbable carbohydrate, commonly used as a bulking agent, delays gastric emptying, slows the intestinal absorption of glucose and, accordingly, attenuates the magnitude of the fall in BP after oral and ID glucose [13,63,84]. Intermittent walking may also be effective in preventing PPH induced by glucose ingestion [67,68]. In terms of the pharmacologic management of PPH, numerous medications have been tested.…”